How to Apply for a Medicaid Provider Number in the State of Florida

Medicaid is a federally funded health care program that provides benefits to U.S. citizens who meet certain eligibility criteria. In order for a Florida medical practice to receive reimbursement from the Medicaid program in exchange for medical services rendered to patients who are enrolled in the Florida Medicaid program, the medical practice must apply for a Medicaid provider number from the state.

Instructions

1. Obtain a Florida Medicaid Provider Application. The application can be downloaded at the Florida Alcohol & Drug Abuse Association's website or by contacting the Florida Agency For Health Care Administration at: 888-419-3456. See the Resources section for a link to the downloadable PDF application.

2. Complete the Florida Medicaid Provider Application. The application consists of several sections, including the main enrollment application, a Non-Institutional Medicaid Provider Agreement and an Electronic Funds Transfer Form. Most medical providers will also need to provide a copy of their professional license from the Department of Health, a copy of Board Certification for Pediatric Surgery and Urology, a Group Practice Sheet (if applicable) and a Certificate of Ownership (if applicable).

3. Submit the completed Medicaid Provider enrollment form to the Florida agency that corresponds with your practice. Applications will be sent to either the Florida Department of Health, Local Area on Aging, Local Agency For Persons With Disabilities, Agency for Health Care Administration, Medicaid Area Office or Local CMS District Office. Applicant providers should consult the submission chart at the end of the application for specific instructions and addresses.

References

• Florida Alcohol and Drug Abuse Association: Guide for Completing a Medicaid Provider Enrollment Application
• Florida Agency For Health Care Administration: Contact

Resources

• Florida Alcohol and Drug Abuse Association: Florida Medicaid Provider Enrollment Application